A 'box' to keep the heart beating

Transplant surgeons have for long complained about how demand for organ transplants vastly out strips supply, and how patients die waiting for an organ or drop out of the list because they are too sick for a transplant. And, many constantly innovate to make use judicious use of harvested organs.

Now, inspired by an expensive commercially available product abroad, a team of doctors in Chennai has come up with a "box" that can keep a heart harvested healthy for up to two hours beyond its four-hour shelf life. The harvested heart is pulled out from the ice pack, thawed and placed in the box that keeps it "alive" - beating, with blood and oxygen flowing through.Patients may be burdened with any additional cost for a heart transplant. We are still working on that,“ said Dr Balakrishnan.“Every time we receive a call about a brain dead donor, the teams rush to retrieve the organs. It's packed in special solutions and placed on ice. Doctors then sprint back to the aircraft or ambulances and ensure they pass through a green corridor -no red signals -to reach the hospital concerned swiftly. It may look extremely dramatic but it is done so because beyond four hours there may be a significant injury to the harvested heart, making it unusable,“ said transplant surgeon Dr K R Balakrishnan.

It may be possible to shift organs within a city in that time, but when the organ has to come from a neighbouring district or from another state, surgeons are often unsure of its quality .

“It's tough to put the harvested organ in a patient when you are not so sure of the quality. The indigenous box we assembled has changed that. It helps patient outcomes. More importantly, there are no additional costs,“ he said.

Initially, doctors at Chennai based Fortis Malar Hospital thought they should buy the commercially available product. Apart from the cost of the equipment, patients had to pay Rs 30 lakh ($45,000) towards disposables. So, doctors assembled one. It has a sterile chamber that gives the heart oxygen supply and a tube that supplies brings blood and nutrients.Recently, doctors began successfully transplanting lungs using a similar device. Data shows that just 10% of lungs donated in India are being used for a transplant because the organ becomes unusable too quickly. Doctors find gram-negative bacteria in the lungs which are often injured or unfit for transplant.

“Lung injury is a common problem we face when called to harvest a lung. Sometimes it may be extremely tough to find this ahead of transplant. Putting it in a box and testing it will hopefully become one of the standards in the future,“ said lung transplant surgeon Dr Madhu Shankar. The new technology will also help doctors treat lungs with antibiotics in the box before transplant.

As of now, doctors use the box only in operation theatres as an experiment. As the next step, it should be used for transporting organs from one hospital to another.

“If we have to take it on ambulances or aircraft, we need electricity to keep the device functional and batteries may become too heavy or expensive. Patients may be burdened with any additional cost for a heart transplant. We are still working on that,“ said Dr Balakrishnan.

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